AB0761 Are we treating-to-target in spondyloarthritis (SpA)? A cross sectional analysis from the Asia Pacific League of Associations for Rheumatology (APLAR) SpA Registry
Authors: I. T. Cheng, H. So, Y. Y. Leung, P. Chiowchanwisawakit, S. Angkodjojo, M. A. Saeed, K. Shin, M. Goyal, M. Haroon, M. Hammoudeh, N. Subramanian, H. Y. Chung, J. C. C. Wei, M. Kishimoto, L. S. Tam
Journal: Annals of the Rheumatic Diseases (2022)

Background Data on the extent of treat-to-target (T2T) recommendations application in SpA patients across Asia Pacific region is lacking. APLAR SpA Registry aimed to assess the utility of T2T on long term clinical outcomes, and to improve disease management and inform health care policy. Objectives To provide a snapshot of the registry including demographics, disease activity and medication use. Methods Patients fulfill the CASPAR 2006 for psoriatic arthritis (PsA) and 2009 ASAS criteria for axial spondylitis (AxSpA) were recruited. This cross sectional analysis included the first 188 patients recruited across 7 Asia Pacific regions (Hong Kong, Singapore, Korea, Thailand, India, Qatar &amp; Pakistan). Results 83 patients PsA and 115 AxSpA patients were included. They had moderate inflammation (DAPSA: 19.61±14.29, ASDAS: 2.32±1.07). Majority of PsA patients received conventional synthetic disease-modifying drug (csDMARDs, 81%) with relatively low prevalence of biologic DMARDs (bDMARDs) (24%). Most AxSpA patients used NSAIDs (79%) while nearly half of them received bDMARDs (49%). Other details listed in Table 1. Prevalence of bDMARDs use in our registry was lower than that from the USA (Corrona PsA Registry, 59%), Turkey &amp; Canada (PsArt-ID, 40%) and the Netherlands AxSpA registry (56%) (1-3). Regarding T2T, 28% and 44% of PsA patient achieved minimal disease activity (MDA) and Disease Activity in Psoriatic Arthritis low disease activity (DAPSA LDA) respectively. The proportion of patients achieving target in other cohorts were 46% for MDA (PsArt-ID) and 46% for DAPSA LDA (Corrona) (1, 2). 37% and 47% of AxSpA patient achieved Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)&lt;4 and Ankylosing Spondylitis Disease Activity Score (ASDAS) LDA. Proportion of patients achieving ASDAS LDA were similar to the Netherlands registry for patients with ASDAS LDA or BASDAI&lt;4 (Figure 1A)(3). Patient on bDMARD were more likely to achieve treatment target (Figure 1B). There were no significant difference between socio-economic status and disease features between bDMARD user and non-user. Table 1. Demographics, clinical features and disease activity of patients PsA (n=83) AxSpA (n=115) Age 50.0 12.8 36.5 12.4 Male n, % 42 51% 85 83% Asian n, % 83 100% 101 96% Disease duration, years 7.1 7.3 5.2 7.6 Any sacroiliitis n, % 102 99% HLA B27, positive n, % 91 89% Duration of early morning stiffness, min 30 39 25 29 Tender joint count 7 9 0 1 Swollen joint count 3 4 0 0 No. of dactylitis digit 1 1 0 0 PASI 4.0 5.0 SPRACC 1 2 0 1 BASDAI 2.8 2.0 ESR, mm/h 31 26 20 16 CRP, mg/L 10 15 11 27 HAQ-DI 0.61 0.61 0.39 0.51 DAPSA 19.61 14.29 ASDAS CRP 2.32 1.07 Data given in mean SD unless stated . No. of case from Hong Kong 40; Singapore 46; Korea 24; Thailand 20, India 15; Qatar 10; Pakistan 33; HLA - human leucucyte antigen; PASI - psoriasis area and severity index; SPRACC - Spondyloarthritis Research Consortium of Canada Enthesitis Index; BASDAI - Bath Ankylosing Spondylitis Disease Activity Index; ESR - erythrocyte sedimentation rate; CRP - C-reactive protein; HAQ-DI - Health assessment questionnaire disability index; DAPSA - Disease activity in Psoriatic Arthritis; ASDAS - Ankylosing Spondylitis Disease Activity Score Figure 1. (A) Achievement of LDA in APLAR SpA registry and other registry and (B) use of bDMARDs among patients in APLAR SpA registry with or without achieving LDA Conclusion Patient using bDMARDs were more likely to achieve treatment target. We expect that when T2T is widely applied, better outcomes will be reported in future. References [1]Bakirci, S., et al. (2019). “What are the main barriers to achieve minimal disease activity in psoriatic arthritis in real life?” Clin Exp Rheumatol 37 (5): 808-812. [2]Beckers, E., et al. (2021). “Treat-to-target in axial spondyloarthritis: an observational study in daily practice.” Rheumatology (Oxford) . [3]Ogdie, A., et al. (2021). “Effect of Multidomain Disease Presentations on Patients With Psoriatic Arthritis in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry.” J Rheumatol 48 (5): 698-706. Disclosure of Interests Isaac T. Cheng: None declared, Ho SO: None declared, Ying Ying Leung Speakers bureau: received honorarium/ speaker fee from AbbVie, DKSH, Janssen, Novartis and Pfizer., Praveena Chiowchanwisawakit: None declared, Stanley Angkodjojo Speakers bureau: Boehringer Ingelheim Singapore in Nov 2021, Consultant of: Abbvie (Singapore), DKSH (Singapore) in 2021, Muhammad Ahmed Saeed: None declared, Kichul Shin: None declared, Mohit Goyal: None declared, Muhammad Haroon: None declared, Mohammed Hammoudeh Speakers bureau: Have you been paid as a speaker for (pharmaceutical) companies, Grant/research support from: participated in drug companies sponsored trials, Nallasivan Subramanian: None declared, Ho Yin Chung: None declared, James Cheng-Chung Wei: None declared, Mitsumasa Kishimoto Consultant of: MK received consulting fees and/or speaker fees from AbbVie, Amgen, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, and UCB Pharma., Lai-Shan Tam Consultant of: has acted as a consultant for Janssen, Pfizer, Sanofi, AbbVie, Boehringer Ingelheim, and Lilly, Grant/research support from: has received grant/research support from Amgen, Boehringer Ingelheim, Janssen, GSK, Novartis, and Pfizer